How Best to Commission Resilient Systems, What Leaders should aim for?

By Nigel Gray

Read the review by Dr Shakeel Siddiqui.

– Chief Officer NHS Leeds North Clinical Commissioning Group

Chair, System Resilience Group (SRG) – Leeds


Nigel’s talk focused on the ongoing work of the SRG in Leeds in developing the principles of leadership and delivery required to create a strong emergency care system


System resilience in Leeds

He started his talk about system resilience in Leeds and what it looks like? He shared his views about some of the principles they have adopted, what type of leadership they are looking for across the whole of Leeds and what they are hoping to deliver? He also shared his paper about winter planning and system resilience in Leeds.

The system resilience group in Leeds is chaired by a GP and it has a range of commissioners and providers on it. The system has to make assurance about robust planning processes, integrated delivery and commissioning. It is aimed at being patient centered, across the whole of the year with high impact changes and interventions linked to appropriate escalation processes. He also talked about understanding risks and mitigation of those risks.

Nigel gave a diagrammatic representation of how the system works. Its complexity shows why at times , people feel they don’t know how to get in and certainly have no idea how to get out of it.. A key component is the IT system which requires much work to make it joined up. In addition, resources and time are limited, processes can be unclear, despite the framework. A major issue is creating the right model for there to be multi routes of entry. .


Building the team,” one step forward”

Throwing light on what is the group doing about these problems, He mentioned about the term, ‘Ask the Team’ which they got together for the rapid improvement in the system. The main aim of this to understand where are we now, planning the journey and looking differently in describing the outcomes. The team comprises a wide range of professionals from all the key disciplines.

He urged the need to engage people at different levels in an organization to understand that this is not just about the doctor’s view or a manager’s view or a system resilience person’s view, this is about how we take people through a journey and get them on board in terms of decision making.. He also enquired of the audience on how to get more and more people on board.

Nigel said that although they had developed a broad vision and a structure, the problem was to engage people to initiate the change. Failure to engage well results in the inevitable resistance to change. Another key message in the process was to keep the proposals as simple as possible.

He went onto highlight a range of initiatives and key strategies that are important at this time.


Vanguard Model

NIgel talked about the Vanguard project and told the audience that West Yorkshire is one of the Vanguard for Urgent and Emergency Care. The project is based halfway between West Yorkshire and Harrogate because the flow of patient comes in from Harrogate in to Leeds as well.

The aim is for all the acute hospital in West Yorkshire to start to work more closely together. A range of strategies are being tried within the Vanguary project that will aim to ensure that patients are cared for as much as possible in the community and only the right group of patients attend the Emergency Department.


Mental Health Access

Mental health in urgent and emergency care as undergone significant improvement in recent years and yet there is still much to be done. A range of initiatives have been launched including the availability of acute mental health services 24 hours a day for example at St. James’s.. Further work is ongoing in this vital area.


Financial modeling

There is no doubt that money needs to follow the patient which it doesn’t at the moment. The various financial models do not adequately support people at home so there is little doubt that we need to think about new payment methodology that has the right incentives. And lastly as primary care starts to provide better extended hours provision this will have a beneficial impact on the urgent and emergency care pathway..


Leadership qualities

Nigel described the importance of co-ordination amongst different teams to breakdown the boundaries of commissioners and providers. This allows people to work together, integrate thinking and hold each other if necessary to account for the actions of the team. This reliance upon each other will help create system resilience and deliver better outcomes. We need to make sure that we have maximise clinical and staff conversations at all levels because change needs to be embedded in staff at all levels to create and deliver a quality service. The audience participated in an active discussion about the strategy paper about to be presented to the Leeds Health and Wellbeing Board.


Final words and take home messages

Mr Gray wrapped up his presentation by explaining some of the very significant financial challenges faced by the National Health Service in Leeds and how the money in the system is being allocated. As he noted ‘its not all a bed of roses, there are a lot of challenges’!



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